PAIN®最新文献

{"title":"Posterior-superior insula repetitive transcranial magnetic stimulation reduces experimental tonic pain and pain-related cortical inhibition in humans.","authors":"Nahian S Chowdhury, Samantha K Millard, Enrico de Martino, Dennis Boye Larsen, David A Seminowicz, Siobhan M Schabrun, Daniel Ciampi de Andrade, Thomas Graven-Nielsen","doi":"10.1097/j.pain.0000000000003488","DOIUrl":"10.1097/j.pain.0000000000003488","url":null,"abstract":"<p><strong>Abstract: </strong>High frequency repetitive transcranial magnetic stimulation (rTMS) to the posterior-superior insula (PSI) may produce analgesic effects. However, the alterations in cortical activity during PSI-rTMS analgesia remain poorly understood. The present study aimed to determine whether tonic capsaicin-induced pain and cortical inhibition (indexed using TMS-electroencephalography) are modulated by PSI-rTMS. Twenty healthy volunteers (10 females) attended 2 sessions randomized to active or sham rTMS. Experimental pain was induced by capsaicin administered to the forearm for 90 minutes, with pain ratings collected every 5 minutes. Left PSI-rTMS was delivered (10 Hz, 100 pulses per train, 15 trains) ∼50 minutes postcapsaicin administration. Transcranial magnetic stimulation-evoked potentials (TEPs) and thermal sensitivity were assessed at baseline, during capsaicin pain prior to rTMS and after rTMS. Bayesian evidence of reduced pain scores and increased heat pain thresholds were found after active rTMS, with no changes occurring after sham rTMS. Pain (prior to active rTMS) led to an increase in the frontal negative peak ∼45 ms (N45) TEP relative to baseline. After active rTMS, there was a decrease in the N45 peak back to baseline levels. In contrast, after sham rTMS, the N45 peak was increased relative to baseline. We also found that the reduction in pain numerical rating scale scores after active vs sham rTMS was correlated with and partially mediated by decreases in the N45 peak. These findings provide evidence of the analgesic effects of PSI-rTMS and suggest that the TEP N45 peak is a potential marker and mediator of both pain and analgesia. This study demonstrates that high-frequency rTMS targeting the posterior-superior insula reduces capsaicin-induced pain and alters cortical activity, with changes in the N45 TMS-evoked potential peak mediating the analgesic effects.</p>","PeriodicalId":19921,"journal":{"name":"PAIN®","volume":" ","pages":"1314-1327"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142829551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges affecting access to pain care in India: why is it different?","authors":"Ketan Bhatt, Patrice Forget","doi":"10.1097/j.pain.0000000000003575","DOIUrl":"https://doi.org/10.1097/j.pain.0000000000003575","url":null,"abstract":"","PeriodicalId":19921,"journal":{"name":"PAIN®","volume":"166 6","pages":"1461-1462"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144023536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Breaking barriers: addressing opioid stigma in chronic pain and opioid use disorder.","authors":"Karlyn A Edwards, Jessica S Merlin, Fiona Webster, Sean C Mackey, Beth D Darnall","doi":"10.1097/j.pain.0000000000003475","DOIUrl":"10.1097/j.pain.0000000000003475","url":null,"abstract":"","PeriodicalId":19921,"journal":{"name":"PAIN®","volume":" ","pages":"1268-1273"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12066799/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142668488","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Visual exposure to green light therapy reduces knee joint pain and alters the lipidome in osteoarthritic rats.","authors":"Melissa S O'Brien, Emily Richter, Taylor Woodward, Heather B Bradshaw, Jason J McDougall","doi":"10.1097/j.pain.0000000000003458","DOIUrl":"10.1097/j.pain.0000000000003458","url":null,"abstract":"<p><strong>Abstract: </strong>Visual exposure to dim, green, light has been found to reduce pain levels in patients living with migraine, low back pain, and fibromyalgia. Preclinical studies discovered that the analgesic effect of green light was due to the central release of endogenous opioids and a reduction in inflammatory cytokines in the cerebrospinal fluid. The present study assessed the effect of green light therapy (GLT) on joint pain in a rat model of osteoarthritis (OA) and investigated the role of endolipids. Male and female Wistar rats (207-318 g) received an intra-articular injection of sodium monoiodoacetate (3 mg in 50 μL saline) into the knee to induce OA. On day 9, animals were placed in a room illuminated by either white (neutral-white 4000K; 20 lux) or green (wavelength: 525 nm; luminance: 20 lux) light for 5 days (8 hours per day). Joint nociception was assessed by von Frey hair algesiometry, dynamic weight bearing, and in vivo single unit extracellular recordings from knee joint mechanonociceptors. Compared to white light, GLT significantly reduced secondary mechanical hypersensitivity in both sexes and improved hindlimb weight bearing in females only. There was no effect of GLT on joint nociceptor activity in either sex. Serum lipidomics indicated an increase in circulating analgesic endolipids in response to GLT, particularly the N -acyl-glycines. Partial blockade of the endocannabinoid system with the G protein receptor-18/cannabinoid-1 receptor antagonist AM281 (500 μg/kg i.p.) attenuated GLT-induced analgesia. These data show for the first time that GLT acts to reduce OA pain by upregulating circulating analgesic endolipids, which then engage the endocannabinoid system.</p>","PeriodicalId":19921,"journal":{"name":"PAIN®","volume":" ","pages":"1274-1284"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12006445/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142505701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pain catastrophizing and pain anxiety mediate changes in physical function in a mind-body intervention for adults with traumatic orthopedic injuries.","authors":"Katherine E Gnall, Kate N Jochimsen, Julie R Brewer, Jafar Bakhshaie, Ana-Maria Vranceanu","doi":"10.1097/j.pain.0000000000003477","DOIUrl":"10.1097/j.pain.0000000000003477","url":null,"abstract":"<p><strong>Abstract: </strong>Traumatic orthopedic injuries are common and frequently associated with persistent pain, disability, and emotional distress. Risk factors of persistent pain and disability include pain catastrophizing and pain anxiety, though most interventions for orthopedic injuries are primarily biomedical (eg, surgeries, pharmacology, physiotherapy/exercise). The Toolkit for Optimal Recovery (TOR) is a brief, live video mind-body program designed to directly target pain catastrophizing and anxiety in patients with recent traumatic orthopedic injury to prevent persistent disability. This study was a secondary analysis from a recently completed multisite feasibility RCT of TOR compared with Minimally Enhanced Usual Care (MEUC). We examined the extent to which the purported mechanisms of change in TOR (ie, reductions in pain catastrophizing and anxiety) mediate improvement in physical function. Participants with a recent orthopedic trauma (N = 195; Mage = 44.01) recruited from 4 Level I trauma centers were randomized to TOR or MEUC and completed self-report surveys at baseline, postintervention, and follow-up (3 months after baseline). A multiple mediation analysis using multilevel structural equation modeling (MSEM) demonstrated that pain catastrophizing (b = -5.22, SE = 3.02, Bootstrapped 95% CIs = -0.04, -12.37) and pain anxiety (b = -8.45, SE = 3.59, Bootstrapped 95% CIs = -0.04, -12.37) each significantly mediated improvement in physical function. Overall, findings elucidate the mechanistic role of TOR's primary treatment targets (ie, reductions in pain catastrophizing and anxiety) in improving physical function. Findings highlight the importance of targeting pain catastrophizing and pain anxiety early after orthopedic injury through psychosocial interventions such as TOR.</p>","PeriodicalId":19921,"journal":{"name":"PAIN®","volume":" ","pages":"1418-1424"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Human cold pain: a randomized crossover trial.","authors":"Felix J Resch, Stefan Heber, Farzin Shahi, Manuel Zauner, Cosmin I Ciotu, Andreas Gleiss, Sabine Sator, Michael J M Fischer","doi":"10.1097/j.pain.0000000000003503","DOIUrl":"10.1097/j.pain.0000000000003503","url":null,"abstract":"<p><strong>Abstract: </strong>The mechanism causing cold pain in humans is unresolved. Animal data suggest a nonredundant contribution to cold pain for transient receptor potential channels TRPM8 and TRPA1 for detection and voltage-gated sodium channels Na V 1.7 and Na V 1.8 for conduction at these temperatures. We established an intradermal injection-based cold pain model, which allows pharmacologically addressing molecular targets at the site of cooling. Lidocaine, added to the injection solution as positive control, largely reduced cold-induced pain in 36 volunteers. The 4 mentioned molecular targets were blocked by antagonists in a double-blinded crossover trial. Pain induced by 3°C intradermal fluid was not reduced to a relevant extent by any of the 4 antagonists alone or by the quadruple combination. However, the temperature threshold for cold pain appeared shifted by the inhibition of TRPA1, TRPM8, and Na V 1.7 and to a lesser extent by Na V 1.8 inhibition, 4-fold inhibition decreased the threshold by 5.8°C. Further mechanisms contributing to human cold pain need to be considered.</p>","PeriodicalId":19921,"journal":{"name":"PAIN®","volume":" ","pages":"1406-1417"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12067611/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854383","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Increasing access to pain care services to improve rural pain management: a realist review investigating factors affecting uptake, implementation, and sustainability.","authors":"Ashley R Grant, Gill Westhorp, Carolyn M Murray, Lenore de la Perrelle, Pascale Dettwiller, Andrew Davey, Abbie Norrish, Sandra Walsh, Gretchen Scinta, Emma L Karran, Peter D Hibbert, G Lorimer Moseley","doi":"10.1097/j.pain.0000000000003482","DOIUrl":"10.1097/j.pain.0000000000003482","url":null,"abstract":"<p><strong>Abstract: </strong>Guideline-based care for chronic pain is challenging to deliver in rural settings. Evaluations of programs that increase access to pain care services in rural areas report variable outcomes. We conducted a realist review to gain a deep understanding of how and why such programs may, or may not, work. Our review incorporated interest-holder input in all review phases. We conducted CLUSTER searching to identify literature relevant to understanding the factors affecting the uptake, implementation, and sustainability of programs offering pain care services to rural general practitioners. We used retroductive analysis to generate and test context-mechanism-outcome configurations. Our results are informed by 74 studies. We identified that awareness of the program, provision of necessary resources, and positive attitudes towards the program are required to enable program uptake. When looking for suitable patients to refer, general practitioners need to trust their ability to discuss a referral with a patient in their allocated appointment time. Program sustainability requires clear roles for all providers and sufficient program coordination. Increased access to pain care services enabled interprofessional learning that increased local providers' confidence to manage chronic pain. Many barriers can interfere with successful uptake, implementation, and sustainability of programs that increase access to pain care services in rural settings. It is important to tailor rural workforce programs to local community needs to increase the likelihood of success. Our findings include recommendations for future program planners to consider.</p>","PeriodicalId":19921,"journal":{"name":"PAIN®","volume":" ","pages":"1250-1267"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143009680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Performance of baseline quartile-stratified minimal clinically important difference estimates was superior to individual minimal clinically important difference estimates when compared with a gold standard comparator of important change.","authors":"Daniel L Riddle, Levent Dumenci","doi":"10.1097/j.pain.0000000000003492","DOIUrl":"10.1097/j.pain.0000000000003492","url":null,"abstract":"<p><strong>Abstract: </strong>A variety of minimal clinically important difference (MCID) estimates are available to distinguish subgroups with differing outcomes. When a true gold standard is absent, latent class growth curve analysis (LCGC) has been proposed as a suitable alternative for important change. Our purpose was to evaluate the performance of individual and baseline quartile-stratified MCIDs. The current study included data from 346 persons with baseline and 12-month postoperative outcome data from KASTPain, a no-effect randomized clinical trial conducted on persons with knee arthroplasty and pain catastrophizing. Subgroup trajectories from LCGC were used as a gold standard comparator. Minimal clinically important difference-specific trajectories of recovery were calculated for the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Pain, Disability and EuroQol-5 Dimension Visual Analogue Scale of self-reported health. The latent Kappa (K l ) chance-corrected agreement between MCIDs and LCGCs were estimated to indicate which MCID method was best at detecting important change. For all 3 outcomes, the average latent class probabilities ranged from 0.90 to 0.99, justifying the use of LCGCs as a gold standard. The K l for LCGC and individual MCIDs ranged from 0.21 (95% CI = 0.13, 0.28) to 0.52 (95% CI = 0.41, 0.66). Baseline quartile-stratified K l for WOMAC Pain and Disability were 0.85 (95% CI = 0.78, 0.92) and 0.74 (95% CI = 0.68, 0.83), respectively. Classification errors in individual MCID estimates most likely result from ceiling effects. Minimal clinically important differences calculated for each baseline quartile are superior to individually calculated MCIDs and should be used when latent class methods are not available. Use of individual MCIDs likely contribute substantial error and are discouraged for clinical application.</p>","PeriodicalId":19921,"journal":{"name":"PAIN®","volume":" ","pages":"1450-1456"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142952971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply to Zhang and Pan.","authors":"Michael F Di Donato, Luke R Sheehan, Ross Iles, Shannon Gray, Rachelle Buchbinder, Alex Collie","doi":"10.1097/j.pain.0000000000003526","DOIUrl":"https://doi.org/10.1097/j.pain.0000000000003526","url":null,"abstract":"","PeriodicalId":19921,"journal":{"name":"PAIN®","volume":"166 6","pages":"1458"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143999161","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparing the brain for pain: new insights and potential biomarkers.","authors":"Jason J Kutch","doi":"10.1097/j.pain.0000000000003485","DOIUrl":"10.1097/j.pain.0000000000003485","url":null,"abstract":"","PeriodicalId":19921,"journal":{"name":"PAIN®","volume":" ","pages":"1221-1222"},"PeriodicalIF":5.9,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12074888/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142771236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}